Provider Demographics
NPI:1659418606
Name:ROBERTSON, SHARUNDAH MICHELLE (RESIDENTIAL COUN 1)
Entity Type:Individual
Prefix:
First Name:SHARUNDAH
Middle Name:MICHELLE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RESIDENTIAL COUN 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 SE 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2016
Mailing Address - Country:US
Mailing Address - Phone:503-788-3187
Mailing Address - Fax:
Practice Address - Street 1:945 NE 165TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-6148
Practice Address - Country:US
Practice Address - Phone:503-408-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion